Q: Is it appropriate to code for a mammogram following a vacuum-assisted, image-guided biopsy and tissue marker placement?

A: The coding for a mammogram following a vacuum-assisted, image-guided breast biopsy and tissue marker placement would depend on the modality used, as well as the number of physicians involved. The biopsy is appropriately coded 19103 for the percutaneous vacuum-assisted breast biopsy using imaging guidance, 76095 for the stereotactic localization, and 19125 for the placement of the tissue marker.

If all of the imaging takes place on a stereotactic machine and is performed by the same physician, the post-procedure mammogram is included in code 76095. Code 76095 includes all of the imaging and work involved by a physician to perform this procedure. Therefore, it is not appropriate to code for the follow-up mammogram.

There are instances, however, when it would be appropriate to code separately for a mammogram post vacuum-assisted breast biopsy. The rationale for this is that the mammogram is a separate procedure using a different imaging modality and it is not essential to the successful completion of the ultrasound guidance procedure.

Another instance when it would be appropriate to code separately for the follow-up mammogram is when a surgeon does the stereotactic procedure and clip placement, and then refers the patient to radiology for a follow-up mammogram or ultrasound. In this instance, it is appropriate for the radiologist to code for the mammogram or ultrasound study performed. This is one of many examples where coding is dependent on whether there is one or multiple physicians involved in the steps of the procedure

Q: How is a magnetic resonance angiography of the aorta with runoff coded? How far do you have to go for it to be considered iliofemoral?

A: Unlike CTA of the abdominal aorta with iliofemoral runoffs of the lower extremity (75635) there is no specific MRA code to describe this study. MRA of the abdominal aorta with iliofemoral runoffs of the lower extremity is appropriately coded using CPTâ code 74185 [Magnetic resonance angiography, abdomen, with or without contrast material(s)] and 73725 [Magnetic resonance angiography, lower extremity, with or without contrast material(s)]. To be considered an iliofemoral runoff procedure, the femoral artery should be included, at least, to the level of the knees.

When a bilateral study of the lower extremities is performed, it is appropriate to submit code 73725 twice. However, you will need to identify for your carrier and other third-party payers that this is not a duplicate charge by assigning a modifier (e.g. –RT, –LT, or –59) to identify that a bilateral procedure was performed.

Q: Is it appropriate to code 72080 for two views of the thoracolumbar spine produced on a DEXA machine?

A: It is the opinion of the ACR’s Committee on Coding & Nomenclature that it is not appropriate to code for 72080 for the two views of the thoracolumbar spine or for any number of spine views when obtained on a DEXA unit in conjunction with a bone scan. The rationale is that CPTâ code 72080 is intended for plain film radiography, and the views obtained on a DEXA unit are not plain film radiography. Code 72080 is specifically for two plain film views of the thoracolumbar spine.